Dr. Akshay's Guide to Recognizing and Managing Pediatric Bradycardia
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This document provides an overview of bradycardia in children, including definitions, types, recognition, ECG characteristics, and management. It describes bradycardia as an abnormally slow heart rate for a child's age that can rapidly lead to cardiopulmonary compromise. The document outlines initial steps to stabilize a child with bradycardia, including checking for hypotension, decreased consciousness, shock, or respiratory distress. It also provides guidelines for determining the heart rate from an ECG and classifying different types of bradycardic rhythms like sinus bradycardia or heart block. Reversible causes of bradycardia are listed as well as an algorithm for treating symptomatic bradycardia with medications.
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Dr. Akshay's Guide to Recognizing and Managing Pediatric Bradycardia
- 1. Recognition & Management of Bradycardia By Dr. Akshay
- 2. Objectives Describe when bradycardia requires immediate intervention. Describe initial steps to stabilize a child with cardiopulmonary compromise. Know when to start CPR in a child with bradycardia. Manage a child as outlined in s Pediatric Bradycardia with Pulse & poor perfusion algorithm Select appropriate medications for treatment of symptomatic bradycardia
- 3. definition Bradycardia is a heart rate that is slow in comparison with a normal heart rate range for the child's age & the level of activity. Bradycardia is an ominous sign!
- 4. Basic Anatomy and Physiology The SA node The AV node Bundle of His Right Bundle Branch Left Bundle Branch
- 6. Recognition of Bradycardia Bradycardia rapidly turns into cardiopulmonary compromise. – Hypotension – Decreased level of consciousness – Shock – Poor-end organ perfusion – Respiratory distress or failure – Sudden collapse
- 7. ECG characteristics Heart rate Slow compared to the normal heart rate for age P waves May or may not be visible QRS complex Narrow or wide (depending on the origin of the pacemaker &/or location of the injury to the conduction system) P wave & QRS complex May be unrelated (AV dissociation)
- 8. What is the paper speed? Normal paper speed 25 mm/sec 1 small square=0.04s 1 big square= 0.2secs
- 9. How to calculate the heart rate? Find 2 adjacent R waves, count the number of big squares between the R’s Divide 300 by the number of big squares : this is your heart rate
- 10. bradyarrhythmias Bradycardia which is associated with rhythm disturbance known as bradyarrhythmias. Common are sinus bradycardia & AV block.
- 12. First degree heart block
- 22. Reversible causes Hypoxia Hydrogen ion (acidosis) Hyperkalemia Hypothermia Heart Block Toxins / poisonings / drugs Trauma
Notas del editor
- Bradycardia is an ominous sign espicially associated with hypotension or e/o poor perfusion… Critical concept if despite of adequate oxygentation & ventilation the heart rate less than 60 in an infent or child with poor tissue perfusion begin CPR.
- The SA node The SA node is the pacemaker of the heart. In sinus arrest, there is failure of the SA node to generate an impulse; whereas in SA block there is an interruption in the transmission of the impulse in the atrium The AV node conducts the electrical impulse from the atria to the ventricles via the bundle of His.
- Primary Bradycardia result of congenital or aquired heart conditions that slow the spontenious depolarisation rate of hewarts natural pace maker cells or slow the conduction through hearts conduction system Causees- congenital anamoly of heart pace maker or conduction system Surgical injury to the pacemaker or conduction Cardiomyopathy myocarditis Secondary Bradycardia noncardiac conditions that alter the normal function of the heart Hypoxia Acidosis Hypotension Hypothermia drugs
- Bradycardia rapidly turns into cardiopulmonary compromise. Cardiac output = stroke volume * heart rate When hr decrease Cardiac output is maintained by increasing in stroke volume, as hearts ability to increase th stroke volm is limited specially in infents cardiac output typically declines with brady cardia leading to cardiopulmonary compromice
- Other types are sinus node arrest with atrial, junctional or ventricular escape rhythms.
- Sinus brady is sinus node discharge rates slower than normal Not necessarily problematic.
- PR interval more than 0.2sec
- Toxins include cholinesterase inhibitors, ca channel dlockers, b adrenergic blokers, digoxin, opioids